Antihypertensive drugs pharmacokinetics evaluation for predicting blood pressure control in comorbid hypertensive patients

Background. Evaluation of the effect of antihypertensive drug (AHD) concentrations on blood pressure (BP) in comorbid patients may help optimize the treatment of arterial hypertension (HTN).
The aim of the study was the effect of the AHD (lisinopril, amlodipine, indapamide) concentration assessment on BP in comorbid HTN patients to optimize antihypertensive therapy.
Design and methods. A prospective clinical controlled study was performed. In comorbid patients with essential HTN and regular use of lisinopril, amlodipine and indapamide, fasting blood samples were taken to determine the concentration of AHD using high-performance liquid chromatography with tandem mass spectrometry. Comorbidity was assessed by Charlson index.
Results. In this study 183 patients were enrolled, the mean age was 63,4 ± 11,1 years, 42,6 % were men. The analysis of covariance (ANCOVA) showed that a decrease in the concentration of each of the studied AHD below the therapeutic range (TR) did not affect the magnitude of daytime and nighttime systolic and diastolic blood pressure (SBP and DBP). At the same time, blood pressure in patients whose concentrations of the two drugs amlodipine and indapamide were recorded below TR, the levels of daytime DBP, nighttime SBP and DBP were statistically significantly (p < 0,05) higher than those in patients with concentrations of all AHD within TR. In one patient concentrations of all three drugs were below TR, and SBP day level was 164 mmHg, DBP day — 102 mmHg, SBP night — 157 mmHg, DBP night — 97 mmHg.
Conclusion. Our results indicate that the decrease in the concentration below TR of at least two antihypertensive drugs (amlodipine and indapamide in our study) affects the level of BP. Analysis of the concentration of AHD in HTN patients may be useful and can increase the treatment effectiveness.

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